Do you recommend routine use of protamine for hemostasis at the end of a transfemoral TAVI?

Always, in order to guarantee hemostasis of the femoral site and minimize femoral access complications. Dose is weight based, anegdotically lots of institutions give half the recommended dose as they still see some of the positive effects. Warning: ask about history of allergy/anaphylaxis. Protramin...

There is an incidence of anaphylaxis in 1-2 %. Therefore, I give it if I have continued oozing or bleeding from the groin rather than routinely. I had witnessed a case of sudden ST elevation that corresponded with quick infusion of Protamine, and immediate angiography showed diffuse coronary spasm t...

The practice of protamine post TAVI is a remnant of an era of > 18 Fr sheaths, with ‘up and over’ PTA-assisted closure, and vascular event rates > 5%.

We don’t use protamine after CHIP, and the IMPELLA CP device goes through a 14 Fr sheath, not very dissimilar to current-generation TAVI sheaths. Clo...